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Home My WebLink About16-272r l IDENTIFICATION NO. J LI9 — Z- Z— t (Office Use Only) ��.:. -4 APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the aapfication (3 19) 356-5040 (319)356-5497 FAX First(� Middle Last 1. Name (REQUIRED) Rooctz KRyE6E2 DATES 2. Address (REQUIRED) y3 („eccwvstw DQ- wEsr isxnNc1-1, TA Sa3r 3. Contact Information (REQUIRED) Email: robAco, 5 a V9 ko,3- c o M Cell Phone:319' y 3o- $balk (All written comm6nication sent via email) 4a. Driver's License expiration date (REQUIRED) 9 — a :- a () a a. b. Taxicab Business Name (REQUIRED) Willow CA6 5. Prior experience in transportation of passengers: 7ctlo w Cnb 01A CAPr t+t coo 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? NO Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? AJO Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 9. Have you ever applied to �bean Iowa City taxi driver using a different name? If yes, please provide the wme(s) fp V U ..-1 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIEQ DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 37oAcCa4-7 issued on /0-3-7-01q expiring on "1-14(-20 as . I understand that if falsely answer any questions in this application, that this application may be denied. I agree that in making this application, consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and documents relating to this application, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date 1 o1 -a l-o�fl ► b STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 2Qjofi f4- on this Z day of 'Dec.e, ,Idtr ZotLe the Stte of I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Gode). Expiration date of DQriverer's license 1 2$ 2022 l._J Signature of Police Chief or designee I 222 I Co Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Signdtttfe of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update la -aa- /L Date CIeMNMIDRIVfl4DGEAPP gMl4am do .DOC 07/2016 WENDY S. MAYER 7 28 My c Bean prey the Stte of I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Gode). Expiration date of DQriverer's license 1 2$ 2022 l._J Signature of Police Chief or designee I 222 I Co Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Signdtttfe of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update la -aa- /L Date CIeMNMIDRIVfl4DGEAPP gMl4am do .DOC 07/2016 �,IOWADOT www.iowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Inquiry Date: Customer Name: Address: 12/13/2016 1992726 Pagel of 2 Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-11211 Fax: 515-239-1837 www. iowadot.gov Certified Abstract of Driving Record DL/ID #: 370AE6247 (IA) CDL Permit Class: None Class: D Dains, Robert Krueger Audit #: 8538064 43 GREENVIEW DR Issue Date: 10/16/2014 City/State: WEST BRANCH, IA 523589627 Mailing 43 GREENVIEW DR Address: Mailing WEST BRANCH, IA City/State: 523589627 Date of 9/28/1971 Birth: Sex: M Expiration 09/28/2022 Date: Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement: History Information CLEAR DRIVING RECORD Name: Dains, Robert Krueger DL/ID: 370AE6247 CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: Office of Driver Services CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: Office of Driver Services CDL Cert Status: None CDL Med Status: None Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a true and accurate copy of an official record currently in the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: -tlinlctE o, >: """•N' ' 12/13/2016 IOWA BAlll%.. Office of Driver Services Iowa Department of Transportation Name: Dains, Robert Krueger DL/ID: 370AE6247 12/13/2016 vec. Iq. LIJio L:VIrml uIv or hrlminaI Investigation No. 9391 P. 3 F•r<ry .:.-...� ... ,.,µy .r„y Glam �.n ice.. ,. i• ......r 12/19/2010 12:07 9760 P.002/002 STATROF IOWA Criminal History Recarei Check Idcguaegt IF`tar1'” 6 � TO: lowu Division of Criminal Investigation Support Operations Bureau, I° Floor 215 T. 7" street Des Moines, lava 50319 (515)725-6066-- _ .. — (515)725-6000 Far: I m11 rertnett;nc an imVn frim;nal {r;Mnrar Rnrnrd ri .nt. ..n. OCY Account Number: LfV 0 -1 —1r (if npplienble) From: City of lowa City City Clerkta Office 410 C. Washington Street tnw9Lity, .1/1 2zan phase: 319-356-5041 Raz: 319356-5497 Last Name (mandatory) First Name (mandato • 0ddle Name (recoomlendad) JbATr✓ 5 906E( -i x(LV6,-E•2 Date of Birth (mandatory) Gender (n,a„duory) Social Security Number recammendee -a�- 1971 YSS-138-7861 Waiver Information., Without a signed waiver from the subject of the request, a complete criminal lllslory record may not be releasable, per Code of lows, Chapter 692.2. For corn le c criminal history record information, as allowed by lain, always obtain a waiver signature from Cha subject of the request. Waiver if eiease; f hereby give permission for the abovc requesting offleial m eo„ducl an Iowa uiminal hislaryrecord cheek with rho Divislon of Criminal lnreeligalion (DCI). My Criminal history data coneernningimeetthat is mmaaimsiotd by the DCI may be released as avowed by law. WfeiverSignrttare:�t�-�"/ /`'�C Iowa Criminal History Record Check Results (Da greenly) eJ As of I %_ �� — o�, a search of the provided name and date of birth revealed: G No Iowa Criminal History Record found with DCI T Iowa Criminal lIistory Record attached, DCI #_ZZ t;;l tnn DCI initials 1XI-77 (08/2S/10) Received Time Dec, 13. 2016 10:48AM No.9908 } Uec.l4. LU Ib L: UL YM U i v of Criminal Investigation ADDITIONAL IDENTIFIERS 01 ARRESTED 19951210 AGENCY: IA0520100 CHARGE NO- 01 OWI TRK#1: 013276201 COURT DISPOSITION AGENCY: IA052015J COUNT NO- 01 ONI TRK#• 013276201 SENTENCE DEFERRED JUDGEMENT CCH RECORD **+ CORALVILLE PD IA STATUTE IA321J-2 JOHNSON CO DIST COURT IA STATUTE: DISP EFP DAT 19960403 PROBATION lY 19960403 40HRS COMM SERVICE AN ARREST WITHOUT, DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION No, 9391 P. 4 IOWA CRIMINAL HISTORY DCT 00512822 COURT DISPOSITION PENDING PAGE 1 OF l STATUS UNKNOWN DATE PRINTED- 2016/12/14 DCI:00512822 NAME; DAINS,ROBBRT KRUEGER DOB SEX RAC HGT WGT EYE HAIR SKM POB 19710928 M W 508 150 BRO BRO FAR IA ADDITIONAL IDENTIFIERS 01 ARRESTED 19951210 AGENCY: IA0520100 CHARGE NO- 01 OWI TRK#1: 013276201 COURT DISPOSITION AGENCY: IA052015J COUNT NO- 01 ONI TRK#• 013276201 SENTENCE DEFERRED JUDGEMENT CCH RECORD **+ CORALVILLE PD IA STATUTE IA321J-2 JOHNSON CO DIST COURT IA STATUTE: DISP EFP DAT 19960403 PROBATION lY 19960403 40HRS COMM SERVICE AN ARREST WITHOUT, DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION No, 9391 P. 4